Healthcare Provider Details

I. General information

NPI: 1336721372
Provider Name (Legal Business Name): THERESE NJOKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27752 MAPLE RIDGE WAY SE
MAPLE VALLEY WA
98038-2009
US

IV. Provider business mailing address

27752 MAPLE RIDGE WAY SE
MAPLE VALLEY WA
98038-2009
US

V. Phone/Fax

Practice location:
  • Phone: 859-801-9218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61035657
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: